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Prior Authorization Specialist- Framingham, MA

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Framingham, United States Protouch Staffing Full time

Prior Authorization Specialist- Framingham, MA

Job Type: Full-time

Shift: Monday- Friday (Days)

Job Summary:

Receive requests for Medical Oncology/Hematology pre-authorizations and ensure that they are properly and closely monitored. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follow prior authorization workflow, policies and procedures. Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner. Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity. Process referrals and submit medical records to insurance carriers to expedite prior authorization processes. Manage correspondence with insurance companies, physicians, specialists and patients as required.

Qualifications/Requirements:

  • High school diploma or equivalent is required.
  • Previous experience as Prior Authorization Specialist is required.
  • Knowledge of insurance processes and medical terminology is required.
  • Prior Authorization experience in an Oncology/Hematology setting is required.
  • EPIC knowledge is a plus

Benefits:
  • 401K
  • Health Insurance
  • Life Insurance
  • Dental Insurance
  • Vision Insurance
  • Paid Holidays
  • Many More